Keeping it zipped: controlling sexually transmitted infections

Four wax heads showing the effects of syphilis and their treatment, Germany, 1910-1920

For an activity that ensures the survival of the human race, sex can be risky. Such intimate contact provides the ideal opportunity for the spread of a number of diseases. Historically, these sexually transmitted infections (STIs) - once known as venereal diseases (VD) - have had effects ranging from minor inconveniences to disfigurement and death. Despite improvements in treatment they remain major public health issues.

The spread of syphilis

The appearance of syphilis in Europe at the end of the 1400s heralded decades of death as the disease raged across the continent. But by the 1800s it had become endemic, carried by as many as 10% of men in some areas. Associated with extramarital sex and prostitution, syphilis was accompanied by much social stigma. The disgrace was such that many sufferers hid their symptoms, while others carrying the latent form of the disease were unaware they even had it. The secretive nature of syphilis helped it spread.

The treatment of syphilis

Until the development of the drug Salvarsan in the early 1900s, the treatment of choice for several centuries was mercury, which had distressing side effects and limited effectiveness. As syphilis - like the other main venereal disease, gonorrhoea - was so difficult to treat, avoiding catching it in the first place was advisable. So in addition to the intense shame society placed on these diseases, some targeted public health measures were introduced, a common focus of which was prostitutes - who were held to be responsible for much of the spread of syphilis.

Government involvement in preventing the spread of syphilis

Alongside prostitutes, another section of the community was also disproportionately affected. This was the military. Limiting the interaction between these two groups has tested the authorities for centuries. In Britain the first Contagious Diseases Act of 1864 allowed the compulsory medical examination of any woman believed by police to be a prostitute, a move that met with much opposition, most notably from Victorian feminist Josephine Butler. It was initially enforced in several towns where troops were stationed, as the act was a direct response to the high levels of VD among troops during the Crimean War.

The effects of syphilis on the military: the First and Second World Wars

Alongside laws, moral pressure remained key to fighting VD. Few soldiers on active service in the 1900s were unaware of the possible physical and social consequences of sexual encounters, dangers that were often backed up with sickeningly graphic imagery. Not that it stopped them though. During the First World War (1914-18) there were nearly half a million hospital admissions for VD among British troops alone. Every day thousands of men were unavailable for active service. This manpower wastage was not forgotten. During the Second World War (1939-45) preventative efforts intensified through films, lectures, posters, leaflets and the greater availability of condoms. Infection rates remained stubbornly high, but treatment times were drastically reduced with the arrival of penicillin. VD cases even gained priority access to the drug if it meant a faster return to the front line. Unlike in the 1800s, medical control had joined moral control in the management of syphilis.

AIDS and syphilis, a similar fearful reaction

When AIDS was first reported in America in 1981 it provoked reactions which echoed those that had accompanied syphilis for so long. That many of the earliest cases were among homosexual men created a climate of prejudice and moral panic. Fear of catching this new and mysterious disease was also widespread among the public. Even toilet seats and used cutlery were eyed with suspicion. More sinisterly, there were calls to introduce compulsory testing, identity cards and quarantine.

Campaigners and charities beat the government to action

As the means of infection became clearer, public health strategies gained focus and attempted to ensure that no groups became scapegoats for AIDS. But much of the drive to increase awareness and distribute advice remained with the campaigners and charities that had first taken the initiative while governments had hesitated. Prevention was central to these strategies, with messages of safe sex and the emergence of the condom as a primary means of protection.

The global spread of AIDS

The observed time-lag between contracting HIV and the onset of AIDS, coupled with new drug treatments, changed perceptions in the West. Increasingly it was seen as a chronic but manageable disease. The global story was different. By the mid-1980s it became clear that the virus had spread, largely unnoticed, throughout the rest of the world. The nature of this global pandemic varies from region to region, but poorer areas have been hit hardest. In parts of sub-Saharan Africa nearly 1 in 10 adults carries the virus - a statistic reminiscent of syphilis in parts of Europe in the 1800s.

The limited success of public health schemes

Hampered by a lack of resources, many regional AIDS-related public health initiatives have had limited effects. The stigma associated with AIDS in parts of the world has also, as with syphilis before it, assisted its spread. With restricted access to drug treatments, many countries relied almost entirely on prevention-only measures. Well over 30 million people are now infected with HIV worldwide, so it is clear that such measures have their limitations.